Liver

The liver is a vital organ located in the upper right part of your belly under the ribs.

Functions of the liver:

Making bile, a yellowish-green liquid that helps with digestion

Producing proteins and blood-clotting factors that the body needs

Regulating glucose (sugar) in the blood and stores extra sugar

Working with the stomach and intestines to digest food

Storing vitamins and minerals

Removing toxic (poisonous) substances from the blood

“Hepatitis” means inflammation of the liver. Hepatitis is also the name of a family of viral infections that affect the liver.

There are 5 types:

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

Hepatitis E

The most common types of hepatitis disease are Hepatitis A, B and C.

Causes of infection and types –

Hepatitis A: This is caused by consuming food or drinking water that is contaminated with faecal matter (human waste). As compared to other infections of hepatitis, hepatitis A usually improves without treatment.

Hepatitis B: It can be transmitted through sexual contact with an infected partner, through infected blood transfusions and dirty needles. Hepatitis B may scar the liver (cirrhosis) and lead to liver cancer.

Hepatitis C: This is the most common form of viral hepatitis. The exact cause is unknown, but it can happen through blood transfusion of infected blood and blood products, contaminated injections and through injection drug use.

Hepatitis D: Hepatitis D occurs in people with hepatitis B, increasing the severity of symptoms associated with hepatitis B.

Hepatitis E: Similar to hepatitis A, hepatitis E happens among people in countries with unhygienic living conditions where contaminated water and food consumption often leads to a spread of infection.

Which hepatitis is dangerous?

Types B and C have been reported more among people leading to a chronic (long-term) illness of liver disease. It is the most common cause of liver cirrhosis (liver tissue scarring) and cancer.

In addition, there are vaccines to prevent Hepatitis A and B. However, there is no known vaccine for Hepatitis C.

Period of illness with different types of hepatitis

Acute Hepatitis viral infection: This is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis virus. Hepatitis A and E may not cause chronic hepatitis but for some with compromised immunity and delayed treatment, it may lead to chronic infection.

Chronic Hepatitis virus infection: Hepatitis viruses B and C can progress from acute to chronic episodes of illness after about 6months. It is long-term as the virus remains in a person’s body and continues to affect liver cells for years to an extent that there can be a complete liver failure.

Pathophysiology of Hepatitis infection

Acute infection: The course of the virus is not completely understood but once it enters into the body, it multiplies and the infection persists due to weak immune responses which fails to control the viral spread of infection. Symptoms will appear and continue.

Chronic infection is established with the progression of infection. Liver lesions appear due to the immune responses and inflammation of the liver cells. It also triggers fibrogenesis in which the cells of the liver become hard, thickened and fibrous. This leads to scarring of the liver tissue known as cirrhosis. People with cirrhosis are then at high risk of developing end stage liver disease (ESLD) with hepatocellular carcinoma (cancer of the liver cells).

Fig 1: Stages of liver infection with Hepatitis C virus(HCV)

Signs and Symptoms with all types of hepatitis

Fever due to infection.

Fatigue due to loss of appetite, nausea, and vomiting. Also, lead to long-term weight loss.

Abdominal pain due to build-up of fluid in the stomach due to inflammation. This occurs when the damaged liver doesn’t produce enough albumin, a substance that regulates the amount of fluid in cells. This may also lead to Pale colored stools, darker urine.

Joint pain: Pain and stiffness are early signs of inflammation caused by the body’s autoimmune response to the hepatitis virus.

Jaundice: Bilirubin present in the hemoglobin of the red blood cells can build up and cause your skin and the whites of your eyes to turn yellow.

Brain problems: A build-up of toxins in the brain can cause personality changes. Advanced symptoms include abnormal shaking, agitation, disorientation, and slurred speech.

Diabetes: Liver is unable to store excess glucose and too much sugar is present in the bloodstream which may lead to insulin resistance or type 2 diabetes.

Who may be at risk of getting Hepatitis?

Infants born to infected mothers can get hepatitis B

Travelers to regions with high risk of Hepatitis infection most commonly reported in Asia, Africa, South America and the Caribbean.

Household members, healthcare professionals and caregivers of infected persons through an accidental transmission.

Recipients of blood transfusions who may have accidentally received an infected blood.

Long-term hemodialysis patients through an accidental infected needle use or blood transmission.

Diagnosis of hepatitis

Blood tests for the antibodies can be helpful in diagnosing both acute and chronic hepatitis. Physical examination of the symptoms along with diagnostic studies such as ultrasound scan of the liver or a liver biopsy is also done to determine the severity of liver damage.

Prevention and Treatment of Hepatitis

Immunization :

Hepatitis A immunization of children (1-18 years of age) consists of 2-3 doses of the vaccine. Adults need a booster dose every 6-12 months following the initial dose of vaccine. The vaccine is thought to be effective for 15–20 years or more.

Hepatitis B vaccines provide protection against hepatitis B for 15 years and possibly much longer. All newborns and individuals up to 18 years of age and adult should be vaccinated. Three injections over a 6 to 12-month period are provided for full protection.

Safety Measures to Prevent Hepatitis

Hygiene: Wash your hands after going to the bathroom and before cooking or eating.

Protective sex: This may lower the risk of transmission. It’s always wise to know the history of your sexual partners, especially if they have an infection, you may run the risk of contracting the disease.

Drinking clean water: Avoid tap water when traveling to certain countries or regions.

Careful handling of drug needles and use of disposable drug needles only.

Once diagnosed with hepatitis, the treatment will depend on the type and stage of infection. Most adults recover completely from acute hepatitis A and B within six months period. Mild relapses may occur over time during the recovery of the disease.

Early detection and treatment show excellent recovery from both hepatitis B and C. Further research development continues to provide a vaccine for hepatitis C.

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